title: Radiation exposure to family caregivers and nurses of pediatric neuroblastoma patients receiving 131I-metaiodobenzylguanidine (131I-MIBG) therapy.
abstract: OBJECTIVE
  (131)I-MIBG provides molecularly targeted radiotherapy for pediatric neuroblastoma patients with relapsed or refractory disease. At our institution, designated family caregivers and nurses participate in the care of the child during hospital isolation for approximately 3-5 days post-administration. The purpose of this study was to measure radiation exposure to family caregivers and nurses caring for children with neuroblastoma during their stay in the hospital for (131)I-MIBG therapy.
  
  
  METHODS
  Iodine-(131)I-MIBG therapy was administered to 14 children (mean age 6.7 ± 3.8 years, range 3-13 years) for relapsed or refractory neuroblastoma from 2009 to 2010. The administered activity ranged from 5.92 to 23.31 GBq (mean 13.65 ± 5.22 GBq). The mean administered activities were 8.77 ± 2.07 GBq (range 5.92-11.1 GBq) and 17.32 ± 3.4 GBq (range 11.84-23.31 GBq) for children less than 7 and 7 years or older, respectively. One or two designated caregivers received specific radiation safety training prior to treatment. One caregiver was allowed to stay in a room adjacent to the child to provide general patient care as instructed by nursing. Nurses assigned to the care of the patient also received specific radiation instructions. The total caregiver and nursing whole body radiation dose was determined using real-time personal dosimetry.
  
  
  RESULTS
  There was no correlation between caregiver (r = -0.068, P = 0.817) or nursing (r = -0.031, P = 0.916) whole-body radiation dose and the patient-administered activity. The overall mean caregiver radiation dose was 1.79 ± 1.04 mSv, but the range of caregiver radiation doses varied by more than an order of magnitude (0.35-3.81 mSv), with no caregiver receiving more than 4.0 mSv. The overall mean nursing radiation dose was 0.44 ± 0.27 mSv per treatment, ranging from 0.15 to 1.08 mSv, with no nurse receiving more than 1.1 mSv. When grouped by patient age, there was no significant difference (P = 0.673) in the mean caregiver exposure for children less than 7 years, 1.94 ± 1.17 mSv (n = 6, range 0.7-3.81 mSv), compared to 1.69 ± 0.99 mSv (n = 8, range 0.35-3.37 mSv) for children 7 years or older. Similarly, there was no significant difference (P = 0.511) in mean nursing exposure for children less than 7 years, 0.5 ± 0.31 mSv (n = 6, range 0.18-1.08 mSv), compared to 0.4 ± 0.24 mSv (n = 8, range 0.15-0.94 mSv) for children 7 years or older.
  
  
  CONCLUSIONS
  There was no significant correlation between caregiver or nursing radiation exposure and patient-administered activity or no significant difference between patient age. This may suggest that older children who tend to receive higher administered activities may require less direct caregiver support during their hospital stay. Most importantly, all caregivers and nurses received radiation doses allowed under current regulations for individuals exposed to therapy patients during hospital isolation (<5.0 mSv), although this does not include exposure the caregivers may receive once the patient leaves the hospital.
authors.affiliation: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Markelewicz
authors.forename: William A
authors.initials: WA
authors.lastname: Lorenzen
authors.forename: Suzanne
authors.initials: S
authors.lastname: Shusterman
authors.forename: Frederick D
authors.initials: FD
authors.lastname: Grant
authors.forename: Frederic H
authors.initials: FH
authors.lastname: Fahey
authors.forename: S Ted
authors.initials: ST
authors.lastname: Treves
mesh_terms: D019797:3-Iodobenzylguanidine / Q000627:therapeutic use*; D000293:Adolescent; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000032:analysis*; D005240:Feasibility Studies; D006761:Hospitals; D006801:Humans; D009447:Neuroblastoma / Q000532:radiotherapy*; D009726:Nurses; D011879:Radiotherapy Dosage; D012449:Safety; D013997:Time Factors
chemical_list: D019797:3-Iodobenzylguanidine